Clinical management of the patient at increased or high risk

There are now interventions to reduce a woman's chance of being diagnosed with breast cancer as well as strategies for the screening of increased or high-risk women. It is essential that clinicians in primary care settings recognize women at increased or high risk of breast cancer due to personal risk factors, medical conditions, or family history, so that appropriate screening activities can be encouraged, appropriate risk-reduction interventions offered, and/or referral made to specialists for cancer risk assessment and counseling. The intent of this chapter is to bring the components of breast cancer risk assessment, risk reduction, and screening, the specifics of which are discussed in depth in other chapters, into a clinical perspective. A practical approach to identifying breast cancer risk, the components of the risk assessment process, and recommendations for the clinical management of women at increased and high risk for breast cancer are reviewed.